[Crystalline lactulose and oral preparations of micro-organisms for the treatment of chronic aspecific diarrhea in children. A controlled clinical study]. / Lattulosio cristallino e preparazioni orali di microorganismi quale trattamento della diarrea cronica aspecifica dell'infanzia. Studio clinico controllato.

Aspecific chronic diarrhea is one of the most common causes of protracted diarrhea in infancy. The pathology is characterised by an increased frequency of daily bowel movement with half-formed feces; it is not associated to malabsorption syndrome or enteric infections and appears to be correlated to an unbalanced diet and changes in microflora involved in the fermentation processes. A controlled randomised single-blind clinical trial was performed, using commercially available crystalline lactulose and lactic enzymes, in order to normalise the modified intestinal ecosystem. Twenty-four children (mean age 21.76 months) affected by aspecific chronic diarrhea were studied; weight and height parameters were not influenced. Patients were first divided by age and then randomly divided into two groups of 12. Group 1 received treatment with crystalline lactulose (Laevolac crystals, BBR) and Group 2 received lyophilised Lactipan. In both cases treatment continued for 15 days. At the end of the trial all subjects showed a complete remission of intestinal disorders. Children in Group 1 showed more fully formed feces following treatment. Fecal pH values were considerably reduced only in those subjects treated with crystalline lactulose. In the latter subjects H2 excretion diminished during the trial, a fact which may probably be attributed to reduced colic pH values. On the basis of these results, it is possible to conclude that both treatments proved efficacious. The re-establishment of a balanced intestinal ecosystem remains the choice treatment for subjects affected by aspecific chronic diarrhea.

Extent of lactose absorption in children with active celiac disease.

We have estimated lactose absorption indirectly by the breath H test to see if disaccharide exclusion is necessary for untreated celiac children. Lactose at 2 g/kg body weight (maximum 50 g) was administered to 42 infants and children (ranging in age from 9 months to 12 years) with flat small intestinal mucosa. Later, different amounts of lactose were given to determine the quantities tolerated and absorbed. One hundred percent of patients expired hydrogen more than 20 ppm over the baseline after an oral lactose load of 2 g/kg (maximum 50 g). Thirty-eight percent of them did not tolerate this quantity. Thirty-seven subjects aged 0-6 years absorbed and tolerated 0.5-1.5 g/kg (5-12.5 g total), and five patients aged 6-12 years absorbed and tolerated 0.5-0.6 g/kg (12-16.2 g total). We conclude that in many subjects with untreated celiac disease, lactase activity is sufficient for absorption and tolerance of the amount of lactose present in 250-300 ml cow's milk. Because of lactose's nutritional value, it should not be excluded unless necessary.

[Giardiasis in children. Ultrastructural study of the parasite]. / Giardiasi in etá pediatrica. Studio ultrastrutturale del parassita.

Giardia lamblia is the first protozoan to be identified and recognized as an important pathogen in human disease. We studied 8 pediatric patients with giardiasis in order to examine the clinical spectrum, the structural changes of the small intestinal mucosa and mainly the protozoan's ultrastructural features. The most common clinical manifestations were diarrhea, abdominal pain, anorexia, vomiting, failure to thrive. Infection was confirmed by excreted cysts in the stools in one patient, by the presence of trophozoites in duodenal aspirate and on jejunal mucosa. Giardiasis was not associated with hypogammaglobulinemia in our patients and no or only slight mucosal abnormalities were present in jejunal biopsies, except one which showed a flat mucosa. Specimens for transmissions and scanning electron microscopy were taken. We could establish the protozoan's features, its normal distribution, its relationship to intestinal mucosa and structural indications of the normal reaction of intestine with the use of ultrastructural techniques. The trophozoites colonized the proximal intestine, adhered to microvilli of columnar cells near the bases of villi, wedged or lodged in mucus. The sticky mucus producing an effective diffusion barrier to nutrients could explain malabsorption phenomena. Numerous intraluminal lymphocytes were seen, suggesting an immune response. These observations indicate that in giardiasis the clinical spectrum and structural changes of the small intestinal mucosa vary widely, suggesting a different reaction of immune system and/or a different degree of infection.